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HX64072720 
RD701  M22  The  permanent  letter     ^^^^_,    ,^,^P^rr,w^«. 

rriE  rnKMANENT  BETTER- 
MENT  OF   THE    CRIPPLED 
CHILD 


BY 

DOUGLAS  C.  McMURTRIE 


PD70I 


±122 


COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

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in  2010  with  funding  from 

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The  Permanent  Betterment 
of  the  Crippled  Child 

An  essay  on  the  operation  of  the  non- 
residential system  of  education  and  care, 
the  social  principles  involved,  and  the 
restoration  of  crippled  children  to  places 
as  useful  members  of  the  community. 
An  account  of  the  work  of  the  Associ- 
ation for  the  Aid  of  Crippled  Children. 

By 
DOUGLAS  C.  McMURTRIE 


New  York 
1911 


Author  G. 

MAY  3 11 912 

Copyright,  1911,  by 
Douglas  C.  McMurtreb 


DOOCLAS  C.  MCMUSTBIS 
NKW  TOHK  ClTT 


THE   PERMANENT   BETTERMENT   OF 
THE  CRIPPLED  CHILD 

The  best  type  of  modern  philanthropy  and 
the  wisest  supporters  of  charitable  work  are 
more  and  more  insistently  demanding  per- 
manent results  in  place  of  temporary  allevi- 
ation. The  real  value  of  any  work  may, 
therefore,  be  well  measured  by  the  final  results 
it  accomplishes.  The  relative  emphasis  placed 
on  the  various  phases  of  work  is  also  of  the 
highest  importance. 

What  are  the  essential  needs  of  the  crippled 
child  can  best  be  judged  by  his  average  cir- 
cumstances. In  most  instances  when  crippled 
children  first  come  under  care  they  have  been 
largely  neglected.  Even  if  wilhng  their  fam- 
ihes  have  probably  been  unable  properly  to 
care  for  them.  In  some  instances  they  may 
have  had  a  certain  degree  of  medical  care,  but 
even  in  such  cases  the  social  and  educational 
considerations  will  have  been  almost  wholly 
neglected. 

As  a  person's  point  of  view  is  to  a  great 
extent  conditioned  by  his  en^^ronment,  so 
the  attitude  of  the  crippled  child  is  determined 


by  his  erperience.  Shut-in.,  neglected,  de- 
prived of  any  educational  advantages,  unable 
to  eura^e  in  a::y  form  of  acti^'ity  and  enduring 
an  existence  devoid  of  any  fun  or  play — the 
crippled  child's  attitude  may  well  be  one  of 
hopelessness  and  discouragement.  And  this 
point  of  view  seems  to  be  \-eri-6ed  repeatedly. 
He  sees  his  sister  start  daily  for  the  public 
school,  he  sees  his  brother  play  in  the  street 
during  the  afternoon  and  the  other  members 
of  the  family  all  d-iinz  their  part  in  the  house- 
hold duties.  Ana  all  these  are  things  which 
the  crippled  child  cannot  do  and  sees  no  hope 
of  Q.jing. 

This  attitude  is  a  diSicuIt  one  to  overcome 
and  there  is  but  one  way  to  do  it.  That  is  by 
piers'jnal  infuenoe  and  sympathy — by  intimate 
wr,rl^  of  the  hnest  sort.  By  patient  effort  of 
this  kind,  however,  it  is  possible  to  restore 
the  child's  self-respect  and  to  recreate  within 
him,  at  it  were,  a  hopeful  spirit  of  self-con- 
fidence. By  proper  training  more  and  more 
of  his  abihties  are  revealed  to  him  and  there  is 
aroused  ambition  which  is,  after  all,  the  main- 
spring ofj  and  incentive  to,  all  effective  en- 
deavor. 


After  this  metamorpliosi.s  is  effected — and 
it  can  be  effected  by  tbe  right  kind  of  effort — 
it  is  amazing  what  the  crippled  child  can 
accomphsh.  He  is  far  from  the  complete 
wreck  we  may  have  thought  him.  In  the 
first  place,  we  find  he  has  an  active  mentahty 
fully  as  Adgorous  as  in  a  child  whose  limbs  are 
straight  and  strong.  His  progress  in  school, 
when  he  is  pro%dded  with  educational  facilities, 
is  astonishingly  rapid,  for,  being  free  from  most 
of  the  diverting  distractions  of  childhood,  the 
appHcation  to  his  one  acti\'ity  is  all  the  more 
intense. 

In  many  other  ways  the  cripple  who  is 
started  in  the  right  direction  CAdnces  unexpected 
abilities.  Several  institutions  have  basebaU 
teams  which  put  up  an  excellent  game,  another 
has  a  brass  band,  others  have  organized  drill, 
and  in  almost  all  classes  and  homes  the  chil- 
dren engage  in  regular  play  and  games. 

The  eventual  aim,  however,  must  always 
be  to  render  the  crippled  child  seK-supporting. 
As  the  deformity  is  only  local  in  one  part  of  the 
body,  lea^dng  the  remaining  members  and 
faculties  active,  with  properly  selected  trade 


instruction  the  cripple  can  be  rendered  inde- 
pendent. 

Consider  the  transformation  —  turning  a 
hopeless,  discouraged  cripple  into  a  hopeful, 
ambitious  and  self-respecting  citizen.  Could 
any  change  be  more  complete  and  more  highly 
to  be  desired.  Yet  this  result  is  being  accom- 
phshed  again  and  again. 

Such  a  change  may  be  pointed  to  as  an  exam- 
ple of  real  and  permanent  betterment. 

And  all  that  needs  to  be  done  is  to  assist  the 
child  in  overcoming  the  special  handicaps 
imposed  by  his  deformity  and  make  avail- 
able to  him  the  ad^'antages  which  every  child 
in  right  and  justice  should  have. 

In  many  cases,  by  proper  methods  of  medical 
and  surgical  care,  a  complete  cure  can  be 
effected  thus  disposing  of  the  entire  problem. 
In  practically  every  case  definite  improvement 
can  be  effected  and  further  harm  forestalled. 
In  cases  requiring  constant  treatment  and 
nursing,  care  in  a  resident  hospital  or  home 
is  demanded.  But  there  is  a  great  class  of 
crippled  children  whose  deformity  is  less  acute 
and  who  need  less  frequent  attention.  The 
members   of   this   class   do   not    and   will   not 


receive  hospital  treatment  in  the  present 
state  of  provision  for  such  requirements.  The 
result  is  that  such  children  remain  at  home 
without  advantages  of  any  kind  and  are,  of 
course,  unable  to  attend  school.  Briefly 
stated,  these  children  can  be  excellently  pro- 
vided for  by  a  comprehensif^e  system  of  \'is- 
iting  nursing,  by  transporting  the  children 
back  and  forth  from  their  homes  to  the  special 
classes  which  are  pro\4ded  for  them  by  the 
public  school  system,  and  by  surgical  care  at 
the  clinics  and  dispensaries. 

It  is  this  sort  of  work  that  is  being  carried 
on  by  the  Association  for  the  Aid  of  Crippled 
Children,  which  in  this  way  is  caring  for  over 
a  hundred  deformed  children.  With  these 
principles,  the  nurses  are  able  to  perform  seem- 
ing miracles,  for  the  hopeless,  discouraged 
little  mites  of  humanity  are  changed  into 
bright  ambitious  boys  and  girls,  looking  for- 
ward to  the  day  when  they  can  learn  a  useful 
trade  and  occupy  a  definite  niche  in  the  com- 
munity. 

The  nurses  ride  with  the  children  to  and 
from  school  each  day  and  \'isit  them  in  their 
homes.     The  home  work,  however,  is  always 


8 


with  the  view  of  supplementing  rather  than 
supplanting  care  from  the  parents.  They 
first  endeavor  to  enlist  the  mother's  interest 
in  sending  her  crippled  child  to  school  and 
they  then  try  to  fortify  this  interest  by  intelli- 
gent direction  and  sympathetic  encouragement. 
Oftentimes  the  mother  has  been  doing  very 
little  for  the  child,  but  this  is  more  frequently 
due  to  ignorance  and  inability  rather  than  to 
intentional  neglect.  Conditions  have  often 
rendered  the  situation  very  difficult  and  the 
burden  of  the  small  cripple  in  the  family  has 
seemed  the  additional  straw  which  was  fatal 
to  the  back  of  the  proverbial  camel. 

When  the  nurse,  however,  shows  the  mother 
what  can  be  done  and  demonstrates  by  prac- 
tical example  that  it  is  as  easy  to  give  the 
child  proper,  as  it  is  to  give  improper,  care, 
conditions  are  materially  altered. 

The  effort  is  always  to  have  normal  needs 
supphed  through  the  medium  of  the  family, 
so  that  the  home  ties  may  be  preserved  un- 
broken and  the  child's  respect  for  his  parents 
may  remain  unimpaired.  When  the  mother 
is  absolutely  unable  to  supply  the  needs  of 
the  child,  the  nurse  is  ready  with  the  required 


assistance;  but  it  is  always  given  where  possi- 
ble through  the  medium  of  the  family,  so  that 
the  child  may  not  come  to  look  for  the  simplest 
elements  of  existence  from  outsiders.  Nothing 
is  more  cruel  than  the  situation  of  a  child  who 
has  lost  respect  for  his  own  father  and  mother. 

There  is  a  great  deal  of  influence  which  the 
nurse  can  exert  directly  upon  their  little  crip- 
pled charges.  In  riding  to  and  from  school 
with  the  children  in  the  omnibuses  each  day, 
the  nurse  is  able  to  inculcate  principles  of 
politeness,  honesty  and  cleanliness.  The  trans- 
formation which  can  be  accomplished  in  a  few 
weeks  with  a  bus  load  of  children  is  astonishing. 

The  general  aim  of  the  work  is  to  make  the 
position  of  the  child  just  as  normal  as  possible. 
This  attitude  is  further  emphasized  by  the 
fact  that  the  children  attend  regular  public 
schools  just  as  do  their  healthier  brothers  and 
sisters.  This  attendance  often  marks  the 
realization  of  a  long-cherished  dream. 

In  keeping  with  this  general  idea  of  healthy 
activity,  the  Association  believes  that  clinical 
work  and  nursing  should  be  excluded  from  the 
schools  in  which  the  children  spend  the  major- 
ity of  their  time,  and  as  the  children  belong 


10 


to  the  class  which  needs  only  clinical  treatment, 
it  is  felt  that  this  may  as  well  be  given  in  a 
hospital.  With  most  of  children,  however, 
the  necessity  for  such  attention  is  fairly  in- 
frequent. 

In  a  general  analysis  of  the  work  of  the 
Association  it  will  be  seen  that  the  children 
are  really  doled  out  very  little  charity  in  the 
old  sense  of  "almsgiving."  As  members  of 
the  community  they  are  entitled  to  their 
education  as  a  right  and  not  as  a  charity,  and 
the  aim  of  the  Association  has  been  to  stimu- 
late the  provision  of  such  education  by  the 
proper  authorities,  and  then  to  make  it  possible 
for  the  children  to  avail  themselves  of  their 
natural  birthright. 

The  children  have  been  receiving  support 
and  some  type  of  care  at  home.  The  Associa- 
tion merely  endeavors  to  supplement  and 
improve  this  care  by  intelUgent  instruction 
and  sympathetic  influence.  In  short,  it  enables 
the  children  to  avail  themselves  of  opportu- 
nities which  are  at  hand  but  which  are  just 
beyond  their  unaided  reach. 

Such  work  is  free  from  the  charge  of  being 
temporary  relief  only.     The  instruction  of  the 


11 


families  in  the  elements  of  proper  care  and  the 
influence  exerted  upon  the  mothers  accomphsh 
permanent  results — results  which  are  effective 
long  after  the  child  passes  from  the  care  of  the 
Association.  Starting  the  child  on  its  educa- 
tional career  accomphshes  results  which  are 
cumulative  in  their  effect  as  he  progresses. 
The  crippled  child  has  great  possibilities;  for, 
with  but  a  little  intelligently  directed  assistance 
to  overcome  the  special  handicaps  imposed 
up)on  him  by  his  deformity,  he  can  be  given 
the  chance  to  succeed  through  his  own  efforts. 
What  the  Association  does  want  to  do  is  to 
guarantee  to  crippled  children  the  chance  to 
make  good  themselves  and  to  give  to  them  the 
square  deal  of  equal  opportunity. 


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